Spokane Board of Health weighs opioid treatment outsourcing amid testy debate

Sep. 26—Amid outcry from patients, the Spokane Regional Health District is at odds over continuing to look into outsourcing opioid treatment services.

The SRHD program has provided direct health care services to the city's residents struggling with addiction for 30 years. When proposing a feasibility study in May on ending the service from the district, SRHD administrator Alicia Thompson said the question over whether a public health agency was the best place for direct opioid services needed a definitive answer after years of discussion.

The first stage of the feasibility study investigated whether another entity would be willing to operate treatment services and gathered community feedback on the possibility of outsourcing. While four entities expressed interest in taking over treatment services, board of health members were unsure in moving forward because of an overwhelmingly negative reaction from patients and staff.

Elizabeth Olsen had been a patient of treatment services for nearly 18 years, saying the program "saved her life" multiple times. Citing poor experiences with private clinics, Olsen told The Spokesman-Review she believes taking treatment services away from SRHD would make care worse and ultimately lead to the death of more addicts who could otherwise get treatment.

"My Dad, my brother, my sister. They all got treated private for drugs, and they're all dead. I'm the only one left alive. And you know why? Because of SRHD being a government clinic. Because treatment services is held just as responsible as they hold us," she said.

According to Olsen, private clinics "only care about profit" and "can do whatever you want."

That perspective was shared among a majority of patients surveyed during the first phase of the feasibility study. Nonprofit Better Health Together hired freelance facilitator Hadley Morrow to conduct an independent survey of patients, staff and the broader public. Morrow, who uses they/them pronouns, found that 91% of respondents preferred treatment services to stay with SRHD.

"The process of asking the question had also caused immense fear from patients who believe such a change could impact their care," they said at the Thursday board meeting.

"I really appreciate the intent of this conversation, but I want to name that it did cause harm. Because for folks who are living with addiction, the fear of any sort of change to their program is drastically scary. And I talked to many people who were feared that any change would cause them to relapse, potentially commit suicide or return to street drugs," Morrow said.

For that reason, Morrow asked the board to end the feasibility study . Treatment services nurse Jill Wells also encouraged board members to do the same.

"This whole situation has triggered a lot of patients right now. They are so anxious, they are so scared — they don't know what they're going to do. There are actually people that are going back out to use again because of this," she said.

If the switch does happen, Thompson noted that patients would go to an organization that would provide equal or better care to clients.

"Treatment services and the incredible support that it provides to our community is not in danger of ending. Treatment services will continue to operate seamlessly, regardless of the outcome of the feasibility study," she said.

Thompson also pointed to potential drawbacks of treatment services being a governmental entity. The program cannot apply directly for federal grants and does not have the agility to change and grow the way a private business could.

Because of this rigidity, treatment services has at times had to turn those away who need services.

"We are having to turn people away from being assessed at treatment services because we do not have the capacity to provide the services to everyone who wants them. Since July 1, we have been unable to assess approximately 120 people who wanted to enroll in our program," she said.

Moving forward with the study would allow the Health District to see if any of the four entities that have expressed interest could do a better job. That includes Behavioral Health Group, Oregon Heath Recovery, Acadia and Camas Health Recovery. Three of these organizations are private, and Camas Health recovery is a public entity of the Kalispel Tribe.

The seven-member Board of Health was split on whether to continue the study at the Thursday board meeting. After more than two hours of discussion, the board agreed to hold off on a vote until its next meeting on the third Thursday of October.

Board member Charlie Duranona said he worried the possibility of change could drive patients of treatment services to use drugs again.

"A cousin of mine is in recovery. I know how hard it is for them to trust, and if we continue on with this thing, I'm nervous that our patients will be more focused on that anxiety than actually getting better," he said.

Board member and Spokane county commissioner Amber Waldref said treatment services should focus on how to improve what it's doing now within SRHD.

"I think we kind of started with the assumption that maybe transferring it would be better, and when I look at the pros and cons and the impact it's having on staff and clients and who are getting excellent service, as far as I understand, I would rather us take a take a break and actually figure out how we could improve the services, the funding, the staffing, so we don't turn away 120 people," Waldref said.

Spokane City Councilmember Michael Cathcart and Spokane County Commissioner Josh Kerns were two voices on the board strongly in favor of moving forward with the study — arguing the process needs to play out to see whether treatment services is best left at SRHD .

Cathcart said it was a "disservice" to the community for the board not to explore every avenue on how to improve treatment.

Kerns said stopping the process midway is not "thoughtful public service."

"I don't think today is the day we decide to just call it quits and end it. Because we don't know what is out there at this point. We don't know if somebody else can offer more. And I think we owe it to the community to find out," Kerns said.

He also clarified that if any entity could not provide a seamless transition and better or equal care, Kerns would not vote for a transfer.

"If we make that abundantly clear there will be no transition unless those standards are met, there should absolutely be no anxiety by folks utilizing this program," he said.